Yankton Sioux Tribe
CDC-Grant Internet Service Application
Fort Randall Telephone Company new/current customers only.

A Credit of $350 will be applied to your existing and/or new account. All applications must include:
1. YST Enrollment Verification
2. Copy of current internet bill with applicants name on it.

Please email applications and/or attachments to Tasheena Tyndall at: ystcovid20tt@gmail.com or fax to 605-384-3830. If you have any questions please feel free to call the Task Force office at 605-384-5683.

Online Applications (See below) - Please fill out the application below and then email attachments.

Application (Print) - Please download, fill out the application and submit to YST.

Name

First Name

Last Name

Contact number:

Country

(###)

###

####

Requested Date of Installation:

Mailing Address | City:

911 Address | City:

Will you be renting or owning your home?

Rent

Own

If renting, Landord's Name:

List any other adults over the age of 18 in the home:

IF YOU ARE AN EXISTING CUSTOMER PLEASE SKIP TO APPLICATION SIGNATURE, SIGN & DATE. For new internet services, select one:

Installation $79.95 *VDSL is not available in all locations.

DSL Internet $49.95 per month

VDSL Internet 25x3 $49.95 + $3 modem charge

VDSL Internet 50x3 $59.95 + $3 modem charge

Username:

Password:

*Password must be at least 6 characters no more than 8.

Customer Credit History | Customer's Previous Telephone Number:

Customer's Previous Address:

How long were you at the above address?

Date of Birth:

Current Employer:

Employer Address:

Employer Phone Number:

Country

(###)

###

####

How long have yoou worked for this company?

Social Security Number: Last four digits only:

Driver's License or ID Number & State

Applicant's Signature

The above information is correct and is given for the purpose of obtaining credit. Fort Randall Telephone Company is authorized to verify this information and to obtain additional information in reviewing this credit request. I hereby agree to the rules and regulations of Fort Randall Telephone Company as set forth in its exchange tariff, and to any general changes in rules, or rates for the services furnished under this application. This application becomes a contract when accepted by Fort Randall Telephone Company.

Application Date:

MM

DD

YYYY

Yankton Sioux TribeCDC-Grant Internet Service ApplicationFort Randall Telephone Company new/current customers only.

Yankton Sioux Tribe
CDC-Grant Internet Service Application
Fort Randall Telephone Company new/current customers only.